RecruitingNot Applicable

Weber B Ankle Fractures With Associated Posterior Malleolus Fracture

Norway198 participantsStarted 2023-03-13

Plain-language summary

Ankle fractures constitute 9% of all fractures and have an incidence of approximately 187 per 100,000 persons per year in Norway. A posterior malleolar fragment (PMF), located on the lower backside of the tibia, is present in up to 46% of Weber B. Weber B fractures are the most common type of fractures of the fibula, located at the height of the syndesmosis. Patients with a PMF were recently shown to have significantly lower patient-reported outcome measures (PROM) than the general population. For this reason, the indication and choice of intervention for these fractures have been the object of increased interest over the recent years. It is one of the most debated areas within ankle fracture surgery. Traditionally, these PMFs have been treated with closed reduction, without direct manipulation of the PMF, anteroposterior screw fixation, or even no-fixation of the smaller fragments. A more novel posterior approach to the ankle for open reduction and internal fixation is increasingly popular and has led to fixation of smaller and medium-sized PMFs. Studies suggest fracture reduction is better with a posterior approach. However, there is no consensus as to what the best treatment is. There are no available randomized controlled studies examining PROM in patients after surgery with fixation versus no fixation for the PMF. Through a multicenter prospective randomized controlled trial initiated from Haukeland University Hospital, patients will be recruited and randomized to receive treatment with or without fixation of the PMF. Patients will be recruited at six study hospitals from all Regional Health Trusts in Norway. Treatment today is often based on local tradition and retrospective, ambiguous literature. As there is no clear evidence supporting the choice to fixate, or not fixate, the posterior malleolus fracture. The current study can contribute new knowledge and thereby contribute to an evidence-based approach to treating these patients. Mason and Molly type 2A and 2B fractures will be included in the study.

Who can participate

Age range18 Years – 65 Years

SexALL

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Inclusion Criteria: * Posterior malleolar (PM) fracture, of Mason \& Molly type 2A/2B, associated with Weber B lateral malleolar fracture, with or without medial malleolar fracture * Posterior malleoli \>=2 mm displaced (on CT in axial, sagital or coronal plane) * Patients informed, written consent * Age 18-65 years * For inclusion axial CT images are examined * Measurements are performed 5 millimeters (mm) cranial to the tibia plafond * Posterior malleolus fractures involving less than 40% of the fibular notch are included. Exclusion Criteria: * Non-compliant patient, i.e.: dementia, alcohol- or substance abuse * ASA-4 patients * Known congenital bone decease * Pathological fractures * Immunocompromised patients * Tourists or patients on a short-term work/study permit * Previous injury or condition of the ipsilateral ankle or ipsilateral lower extremity with a resulting dysfunction * Poor controlled diabetes * Patients with known arterial insufficiency * Open fractures * Severely traumatized patients (ISS\>16) * Patient declines to participate in study

What they're measuring

Self-Reported Foot and Ankle Score

Timeframe: 2 years postoperatively

Trial details

NCT IDNCT05413707

SponsorHaukeland University Hospital

Sponsor typeOTHER

Study typeINTERVENTIONAL

Primary completion2025-12-31

Contact for this trial

Jostein S Nilsen, MD

004792226426 jostein.skorpa.nilsen@helse-bergen.no